Gender Differences in Perception of Dyspnea, Assessment of Control, and Quality of Life in Asthma
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Abstract:
There is limited information on the inter-relationship between gender, perception of dyspnoea and health-related quality of life (HRQoL) in asthma.In a cross-sectional study in an out-patient setting, 85 patients with bronchial asthma, 41 males and 44 females, underwent spirometry and were administered the following instruments to measure asthma control, HRQoL and dyspnoea : (a) Asthma control questionnaire (ACQ), (b) Asthma Quality of Life questionnaire (AQLQ), (c) Baseline dyspnoea index (BDI) questionnaire and Oxygen Cost Diagram (OCD).Overall, male patients had greater airways obstruction but reported similar level of asthma control as females. Among patients with mild persistent asthma, females had a poorer level of control. The BDI and the OCD scores were significantly lower in female patients indicating greater dyspnoea and they also had a poorer quality of life especially in the symptoms and emotional domains of the AQLQ. After adjusting for the severity of airways obstruction in multivariate analysis, female gender and a poorer quality of life were independent predictors of increased perception of dyspnoea.Female patients with asthma are likely to have a greater perception of dyspnoea, report a poorer control and have a poorer quality of life as compared to males. Female gender and a poorer quality of life are independent predictors of increased perception of dyspnoea in asthmatics.Keywords:
Airway obstruction
Cross-sectional study
Chronic obstructive pulmonary disease (COPD) case-finding aims to detect airflow obstruction in symptomatic smokers and ex-smokers. We used a clinical algorithm including smoking, symptoms, and spirometry to classify smokers into COPD risk phenotypes. In addition, we evaluated the acceptability and effectiveness of including smoking cessation advice in the case-finding intervention.Smoking, symptoms, and spirometry abnormalities (airflow obstruction: forced expiratory volume in 1 second [FEV1] to forced vital capacity [FVC] <0.7 or preserved-ratio spirometry (FEV1<80% of predicted value and FEV1/FVC ratio ≥ 0.7)] were assessed in a group of 864 smokers aged ≥ 30 years. The combination of these parameters allowed the identification of 4 phenotypes: Phenotype A (no symptoms, normal spirometry; reference), Phenotype B (symptoms; normal spirometry; possible COPD), Phenotype C (no symptoms; abnormal spirometry; possible COPD), and Phenotype D (symptoms; abnormal spirometry; probable COPD). We assessed phenotype differences in clinical variables and modeled the trend from phenotype A to phenotype D. Smoking cessation advice based on spirometry was provided. Follow-up was done by telephone 3 months later.Using smokers without symptoms or abnormal spirometry (phenotype A; n=212 [24.5%]) as a reference, smokers were classified into possible COPD (phenotype B;n=332 [38.4%]; and C: n=81 [9.4%]) and probable COPD (phenotype D: n=239 [27.2%]). The trend from baseline phenotype A to probable COPD phenotype D was significant for the number of cigarettes/day and the number of years of smoking (p=0.0001). At follow-up, 58 (7.7%) of the respondents (n=749) reported that they had quit smoking.Our clinical algorithm allowed us to classify smokers into COPD phenotypes whose manifestations were associated with smoking intensity and to significantly increase the number of smokers screened for COPD. Smoking cessation advice was well accepted, resulting in a low but clinically significant quit rate.
Vital capacity
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หลกการและวตถประสงค : การวนจฉยโรคปอดอดกนเรอรงทถกตองมความสำคญตอการรกษา ในประเทศไทยการวนจฉยโรคปอดอดกนเรอรงมกอาศยอาการทางคลนกเปนหลก เนองจากการตรวจ Spirometry ไมสามารถทำไดในทกโรงพยาบาล แตตามเกณฑการวนจฉยโรคปอดอดกนเรอรงจำเปนตองอาศยผลการตรวจ Spirometry งานวจยนจงมวตถประสงคเพอศกษาผลการตรวจ Spirometry และปจจยทมความสมพนธกบคณภาพการทดสอบ Spirometry ในผปวยทไดรบการวนจฉยจากอาการทางคลนกวาเปนโรคปอดอดกนเรอรง วธการศกษา : การศกษานมรปแบบเปน Observational study โดยผปวยทไดรบการวนจฉยวาเปนโรคปอดอดกนเรอรงจะไดรบการประเมนโดยอาศยแบบเกบขอมลและไดรบการตรวจ Spirometry ผลการศกษา : มผปวยเขารวมงานวจย 168 ราย เปนเพศชาย 133 ราย หญง 35 ราย อายเฉลย 68.3±10.3 ป มประวตสบบหรรอยละ 72 มประวตเคยเปนวณโรคปอด 59 ราย (รอยละ 35.1) มโรครวมในกลม Metabolic syndrome และโรคหวใจและหลอดเลอด 73 ราย (รอยละ 43.4) มผลการตรวจ Spirometry ไดคณภาพ 99 ราย (รอยละ 58.9) ในกลมทผลการตรวจไดคณภาพพบวาเขาไดกบโรคปอดอดกนเรอรง 34 ราย (รอยละ 34.3) และพบวา อายทเพมขน, คะแนน mMRC ≥ 2 หรอ CAT score ≥ 10 มความสมพนธกบคณภาพการทดสอบ Spirometryอยางมนยสำคญทางสถต สรป : จากการศกษาพบวาผลการตรวจ Spirometry ไดคณภาพรอยละ 58.9 ในกลมทผลการตรวจไดคณภาพพบวาเขาไดกบโรคปอดอดกนเรอรงรอยละ 34.3 โดยปจจยทมความสมพนธกบคณภาพการทดสอบ Spirometry ไดแก อายทเพมขน, คะแนน mMRC ≥ 2 หรอ CAT score ≥ 10 Background and Objective: Effective treatments of COPD rely on the accurate diagnosis. In Thailand COPD is mainly diagnosed by observing clinical manifestations because spirometry test cannot be performed in all hospitals. However, accurate COPD diagnosis needs spirometry test. The objective of this study was to evaluate spirometry test results and factors associated with quality of spirometry test in patients diagnosed with COPD from clinical manifestations. Methods: An observational study was applied in this study for assessing patients diagnosed with COPD by using a case record form and performing spirometry test. Results: There were 168 patients involved in the study, 133 males, 35 females; mean age 68.3 ± 10.3 years. Seventy-two percent of patients had history of smoking, 59 patients had undergone pulmonary tuberculosis (35.1%), 73 patients (43.4%) experienced comorbidities belonging to metabolic syndrome and cardiovascular diseases. Ninety-nine patients had valid spirometry test results (58.9%). Those with valid ones demonstrated that 34 patients met GOLD criterion for COPD diagnosis (34.3%). Increased age, mMRC dyspnea scale ≥ 2 or CAT score ≥ 10 had statistically significant association with quality of spirometry test. Conclusion : There were 58.9% of patients had valid spirometry test results. Those with valid ones demonstrated that 34.3% met GOLD criterion for COPD diagnosis. Factors associated with quality of spirometry test were increased age, and mMRC dyspnea scale ≥ 2 or CAT score ≥ 10.
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Variability during spirometry can persist despite control of technical and personal factors. We postulate spirometry induces gastro-oesophageal reflux (GOR), which may cause variability and affect results of spirometry. Fifty-eight (58) subjects undergoing GOR investigation with oesophageal manometry and 24hr pH monitoring were recruited. Oesophageal dysmotility and GOR were assessed as part of clinical care. Subjects performed 2 sets of spirometry separated by a 10-minute rest period. The assessment of GOR during spirometry procedure (defined by a lower oesophageal pH<4) started from the first set of spirometry and concluded when the second set of spirometry was completed. We calculated variability (%) of FEV1, FVC and PEFR within each set as well as changes over 10-minutes. Twenty-six subjects (45%) recorded GOR during assessment. Of these, 23 subjects recorded GOR during the 10-minute rest period. Four subjects had GOR recorded only during spirometry tests. We did not find variability of spirometry parameters between the groups with and without GOR during spirometry procedure. However, in subjects with GOR, we found small but significant reductions of PEFR (0.5L/s, 8%, p<0.001) and FEV1 (84 mL, 3%, p = 0.048) in the second set of spirometry compared to the first spirometry set. This pilot study demonstrates that GOR can occur during and following spirometry. Presence of GOR during spirometry in this patient population caused small decreases in PEFR and FEV1 when it is repeated 10-minutes later however not increase variability in a single series of measurements.
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Introduction
Asthma guidelines recommend that spirometry should be used for monitoring the condition in children. Surprisingly there is no link between rising or falling spirometry and treatment change. Here the feasibility and acceptability of a 'spirometry trial' was explored.Methods
Principle investigators (PIs) on an ongoing asthma clinical trial were contacted asking 'Would your centre be able to take part in a randomised controlled trial where patients would be randomised to treatment by spirometry plus symptoms versus symptoms only?'Results
All 34 PIs replied. 26 centres would be happy to recruit patients but 8 centres would not recruit. Tertiary centres accounted for 42% (11) of centres able to recruit and 63% (5) of centres unable to recruit. In addition to the distinction between tertiary and DGH centres there were at least two themes which emerged from the centres. First, there was considerable variation in practice. Some centres were using spirometry routinely and considered it a useful test, especially among young adults, whereas other centres were not regularly using spirometry: 'We would be uneasy about the lack of spirometry as there are many who under-report symptoms and we often treat on the basis of risk using FEV1.' Tertiary centre clinician (TCC). 'Our centre always performs spirometry as part of chest patient assessment.' TCC. 'Spirometry is not in such routine use here that would preclude interest in a trial'. DGHC. 'Our local team aren't particularly wedded to spirometry so we're happy to randomise'. DGHC. A second theme was a willingness to determine what the role of spirometry was in asthma management. 'I happen to believe firmly that every child with asthma should have spirometry on every visit, but in the spirit of 'no action without evidence', count XXXX in.' TCC. 'We agree we sometimes get into a rut with what we think we should be doing and happy to challenge the dogma'. DGHC.Conclusion
This survey gives insight into the inconsistency among clinicians of the role of spirometry in managing childhood asthma. The time is ripe for a formal evaluation of the role of spirometry in guiding asthma treatment.Cite
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Background: Variability during spirometry can persist despite control of technical and personal factors. We postulate spirometry induces GOR, which may cause variability of spirometry. Aims and Objectives: Pilot study assessing prevalence of GOR during spirometry and its effects on spirometry variability in subjects having outpatient GOR assessment. Methods: At the end of oesophageal manometry and 24hr pH monitoring, 56 subjects performed 2 sets of spirometry separated by a 10-minute break. We quantify 24hr GOR with the De-Meester score (≥14.72 in significant GOR). Assessment for GOR during spirometry starts with 1st spirometry and ends with 2nd spirometry. Variability of spirometry (%)=max value-min value/max value x 100. Results: 26 subjects (44%) had GOR during assessment: 18 during the 10-minute break with 3 persisting into the 2nd spirometry, 5 throughout assessment, and 3 during spirometry only. They tend to have higher De-Meester scores (mean 39.8 vs 26.8, t test p=0.13) and are more likely have a GOR event preceding the 1st spirometry (median time interval [min] 8.5 [IQR 5–12] vs 25 [IQR 10–70]), compared to 30 subjects without GOR during spirometry assessment. 15 subjects with GOR had reproducible spirometry: mean 2nd FVC and FEV1 were non-significantly higher by 20 & 12mL respectively. Mean variability of spirometry (%) ± SD was similar between GOR and non-GOR groups: Conclusion: GOR occurs during and following spirometry in subjects having outpatient GOR assessment, but does not significantly impact spirometry variability over 10 minutes.
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To develop and evaluate a computer program for interpretation of spirometry.The spirometry programme was constructed in Epi Info software using a previously defined algorithm for interpretation. The programme incorporated current American Thoracic Society guidelines on interpretation of spirometry and was based on regression equations for healthy North Indians previously derived by us. The programme was pretested for two months before being put to routine use.Use of this spirometry programme led to consistent interpretation of spirometry results. There was significant saving of time while preparing reports, without any additional expenditure.The use of such computer programmes accelerate the reporting of pulmonary function test results at little extra cost, and all interpretations are performed in a consistent fashion.
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The use of spirometry to determine pulmonary function has been complicated by the proliferation of measurements possible from the expiratory effort. Non-pulmonary physiologists face the problem of making a choice between a multiplicity of spirometric tests. Some guidelines for ventilatory testing are offered. The various uses of spirometry are indicated and those tests which best subserve these uses are suggested.
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Aim: To assess the quality of spirometry sessions in patients with COPD exacerbation; to compare the spirometry quality in patients with frequent exacerbations (two or more in the previous year) and in patients without exacerbations. Subjects and methods: Consecutive COPD patients with moderate infectious exacerbation were evaluated at presentation. The quality of spirometry (ATS/ERS 2005: at least 3 acceptable curves with repeatable values for FVC and FEV1) and the time needed to obtain a spirometry session were evaluated and compared to the spirometries obtained 3-6 months previously in a stable period. Results: 80 COPD patients were evaluated, mean age 63 years, 60 males. Although all patients had valid spirometry sessions in the stable period, 12 subjects (15%) could not obtain a valid session during exacerbation due to cough, shortness of breath and/or fatigue. More efforts were necessary to obtain a spirometry session during exacerbation (4.6±1.2 efforts) compared to the stable period (3.8±0.9 efforts, p=0.001). The time needed to obtain a spirometry session was significantly higher in exacerbation (5.7±1.4 minutes) compared to the stable period (4.8±1.6, p=0.001). Frequent exacerbators (33 patients, 41%) had similar spirometry quality in exacerbation and in the stable period, and similar amount of time needed to perform the spirometries compared to the patients with no exacerbations (p>0.05). Conclusions: Lower spirometry quality and higher time needed to obtain a spirometry session were seen in exacerbation compared to a stable COPD period. Similar spirometry quality was seen in patients with frequent exacerbations as in patients without exacerbations in the previous year.
Copd exacerbation
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Objectives: Compare Spirometry and Impulse oscillometry as a lung function modality in diagnosis and assessment of children with asthma. Methods: Study Design: Cross-sectional Method: We enrolled 100 children (between 4 to 18 years) with suspected or known asthma during (June 2017-Sept 2018). All underwent lung function testing after detailed history and physical examination. Results were analyzed and compared using SSPS version 17.0 software to assess the yield of Spirometry and IOS in asthma diagnosis and control. Results: Out of 100 children performing lung function testing, 80% were able to perform Spirometry, while 100% successfully performed IOS. 16 out of 80 cases on spirometry met GINA criteria. On IOS 66 out of 100 cases met the criteria of asthma.. The overall diagnostic yield of spirometry was 16 % as compared to 66 % on IOS. Among 61 suspected asthma cases diagnostic yield of Spirometry and IOS 4.9% and 60.6% respectively, while among 39 known cases yield was 33.3% and 74.4%. Diagnostic yield of spirometry and IOS among preschool (4-6 years) was 6% and 82% respectively. And among the school age group it was 21% and 57.5%. Also in 55 cases only IOS was diagnostic and in 6 cases only spirometry was diagnostic, showing discordance. On comparing spirometric parameters, FEV1 was statistically correlated with R5 ( r=-0.59, p=0.00), R20 (r= -0.45, p=0.00) and AX (r=-0.60 , p= 0.00), which are markers of peripheral airway obstruction on IOS. Conclusion: IOS is easy to perform , has less failure rate, has better diagnostic yield and provides better assessment of asthma control.
Airway obstruction
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